Nivolumab Shows Durable Benefit for Advanced Melanoma


“Patients with surgically resected stage III or stage IV melanoma at high risk for recurrence maintained longer RFS after adjuvant treatment with nivolumab then standard ipilimumab, according to long-term efficacy results from the CheckMate 238 clinical trial presented at ASCO Annual Meeting.

“‘These more mature data continue to demonstrate durable clinical benefit with nivolumab and further support its use for resected stage III or IV melanoma,’ Jeffrey S. Weber, MD, PhD, deputy director of Perlmutter Cancer Center at NYU Langone Health, said during his presentation.”

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Vemurafenib Fails to Significantly Improve DFS in Resected Melanoma


“Vemurafenib offered numerical improvement in disease-free survival in a study of patients with completely resected stage IIC to IIIC BRAF V600 mutation–positive melanoma, but the results did not reach statistical significance. The benefit was bigger in those with stage IIC to IIIB disease, but this should be considered exploratory at this point.

” ‘Despite full resection, patients with stage IIC to III melanoma remain at high risk for disease recurrence and death,’ wrote study authors led by Michele Maio, MD, of University Hospital of Siena in Italy. ‘This situation warrants the use of adjuvant approaches to improve clinical outcomes.’ ”

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Adjuvant Chemotherapy Associated with Shorter Survival in LCNEC

“Patients who underwent adjuvant chemotherapy for pulmonary large cell neuroendocrine carcinomas demonstrated poorer 3-year survival than those who did not undergo adjuvant treatment, according to study results presented at the American Association for Thoracic Surgery Annual Meeting.

“ ‘We did not see any particular subset of patients who may benefit from this treatment,’ researcher Pier Luigi Filosso, MD, of the University of Torino in Italy, said during a presentation.

“Filosso and colleagues conducted a retrospective cohort study to determine the impact of adjuvant chemotherapy in patients with resected large cell neuroendocrine carcinomas (LCNEC). The analysis included 400 patients with LCNEC who underwent surgery between 1992 and 2014 at one of 14 institutions worldwide.

“Researchers used the Kaplan-Meier method to estimate OS after resection. Propensity score for the likelihood of receipt of adjuvant chemotherapy was estimated based on patient age, gender, prior malignancy, ECOG performance status, TNM stage and year of surgery.”

Postop RT Boosts Survival in NSCLC

The gist: Last month news came out that people who undergo surgical resection to treat their non-small cell lung cancer (NSCLC) might live a few months longer if they receive radiation therapy after surgery. This article provides more in-depth coverage of the topic.

“Postoperative radiation therapy conferred a significant survival advantage for patients with non-small cell lung cancer (NSCLC), a review of more than 2,000 cases showed.

“Patients who received radiation therapy after surgery had a median overall survival of 42 months compared with 8 months for patients who had surgery without irradiation (P=0.048). The survival benefit was affirmed by a multivariate analysis, John L. Mikell, MD, of Emory University in Atlanta, reported at the Multidisciplinary Symposium in Thoracic Oncology in Chicago.

“The findings add to what has been a controversial history for adjuvant radiation therapy in resected NSCLC. Some data suggested that postoperative irradiation improved outcomes in patients with N2 nodal involvement, providing the rationale for investigation.

“Mikell and colleagues analyzed data from the National Cancer Data Base and identified patients with resectable NSCLC treated during 2004 to 2006. They excluded patients with positive margins, incomplete survival data, no adjuvant chemotherapy, histology other than NSCLC, and patients treated with cobalt-60, nonbeam radiotherapy, or neoadjuvant therapy.”

Post-Operative Radiation Therapy Improves Overall Survival for Patients with Resected NSCLC

The gist: People who undergo surgical resection to treat their non-small cell lung cancer (NSCLC) might live a few months longer if they receive radiation therapy after surgery. So-called post-operative radiation therapy (PORT) was tested in a clinical trial with volunteer patients. On average, patients in the trial who received PORT lived four months longer than did similar patients who did not receive PORT. The trial specifically focused on patients who had T2 tumors, meaning that tumors had spread to lymph nodes in the center of the chest. Chemotherapy is already sometimes given after surgery to help ensure that the cancer does not come back. Now, oncologists may also decide to consider PORT for their patients.

“Patients who received post-operative radiation therapy (PORT), radiation therapy after surgery, lived an average of four months longer when compared to the patients who had the same disease site, tumor histology and treatment criteria and who did not receive PORT, according to research presented today at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. The Symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago Medicine.

“This study reviewed the records of non-small cell lung cancer patients treated from 2004 to 2006 from the National Cancer Data Base (NCDB), a joint endeavour of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The study authors acquired the data for patients who had surgically resected non-small lung cancer with pathologically involved N2 (pN2) lymph nodes (tumors had spread to the lymph nodes in the center of the chest (the mediastinum)) and who received chemotherapy. The database was further queried to exclude patients with positive margins, incomplete survival data, those who did not receive adjuvant chemotherapy, histology other than NSCLC, and patients treated with Cobalt-60, non-beam radiotherapy or neoadjuvant radiotherapy. Two thousand one hundred and fifteen patients (2,115) met all of the study criteria. Forty-three percent of patients (918) received PORT; 56.6 percent of the patients (1,197) were not treated with PORT…

” ‘These results reinforce the value of PORT for non-small cell lung cancer patients with involved mediastinal lymph nodes. Our data indicates that with modern radiotherapy equipment and treatment techniques, PORT can improve survival for these patients,’ said John L. Mikell, MD, lead study author and chief resident in the Department of Radiation Oncology at Emory University Winship Cancer Institute in Atlanta. ‘The data in this study, the largest, most recent cohort of patients with involved mediastinal nodes treated with chemotherapy reinforce that PORT should be considered in addition to chemotherapy following resection of non-small cell lung cancer.’ “

ESMO 2014: Lung Cancer Vaccine Fails to Improve Survival in Surgically Resected Non–Small Cell Lung Cancer

The gist: Cancer vaccines are a form of immunotherapy—treatment meant to boost a patient’s own immune system to fight cancer. Unfortunately, they have not proven very successful when tested in lung cancer patients in clinical trials. The disappointing trend continues with new results from a clinical trial testing a vaccine called MAGE-A3. However, we posted a story yesterday about scientists’ hopes that cancer vaccines may start working better when paired with certain drugs called checkpoint inhibitors.

“The MAGRIT trial showed disappointing results for a developmental vaccine called MAGE-3 in patients with non–small cell lung cancer (NSCLC) who had undergone surgical resection. This is the largest vaccine trial conducted in lung cancer, and investigators hoped that an immunotherapy approach with a vaccine would improve outcomes. The findings were presented at the ESMO 2014 Congress in Madrid (Abstract 1173O).

“At present, about 45% of patients are cured by surgery with or without chemotherapy, and better therapies are needed.

“ ‘Vaccinations give us effective soldiers, but in this case they didn’t work on the battlefield,’ stated lead author Johan F. Vansteenkiste, MD, Catholic University Leuven, Belgium. He noted that other trials have shown that lung cancer vaccines elicit antibodies and immune cells (ie, “soldiers”) that can kill cancer cells, ‘but the problem occurs when they come to the battlefield, ie, the environment of the tumor where they are paralyzed by factors in the tumor.’

“On the plus side, the MAGE-3 cancer vaccine was well tolerated and the investigational effort identified a predictive marker for treatment benefit—the MAGE-A3 protein. Of the nearly 13,500 NSCLC patients screened for the study, one-third had tumors that expressed MAGE-A3—similar to the expected distribution in NSCLC.”

Randomized, Double-Blind, Placebo-Controlled, Phase III Chemoprevention Trial of Selenium Supplementation in Patients With Resected Stage I Non–Small-Cell Lung Cancer: ECOG 5597

Selenium has been reported to have chemopreventive benefits in lung cancer. We conducted a double-blind, placebo-controlled trial to evaluate the incidence of second primary tumors (SPTs) in patients with resected non–small-cell lung cancer (NSCLC) receiving selenium supplementation.

Selenium was safe but conferred no benefit over placebo in the prevention of SPT in patients with resected NSCLC.